Canadian Community Health Survey Healthy Research Articles

Sex-based trajectories of health system use in lonely and not lonely older people: A population-based cohort study.

There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey. We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three-Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 -year observation period. Annual risks of moving from the community to inpatient, long-stay home care, long-term care settings-and death-were estimated across loneliness levels using sex-stratified multistate models. Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long-term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2-year home care risk: 6.1% [95% CI 5.5-6.6], 8.4% [95% CI 7.4-9.5] and 9.4% [95% CI 8.2-10.9] in female respondents, and 3.5% [95% CI 3.1-3.9], 5.0% [95% CI 4.0-6.0], and 5.4% [95% CI 4.0-6.8] in male respondents; 5-year long-term care risk: 9.2% [95% CI 8.0-10.8], 11.1% [95% CI 9.3-13.6] and 12.2% [95% CI 9.9-15.3] [female], and 5.3% [95% CI 4.2-6.7], 9.1% [95% CI 6.8-12.5], and 10.9% [95% CI 7.9-16.3] [male]). Lonely older female and male respondents were more likely to need home care and long-term care, with severely lonely female respondents having the highest probability of moving to these settings.

Sedentary time at school and work in Canada

ObjectivesHigh levels of sedentary time (ST) are associated with poor physical and mental health. Given that Canadians spend a large portion of their days at school and work, they may be important targets for reducing ST. Our objectives are to estimate the daily amount of school and work ST among Canadians, examine differences by subgroups, and determine associations with health.MethodsUsing the 2020 Canadian Community Health Survey Healthy Living Rapid Response module (N = 5242), the amount of time spent sitting while at school and work was estimated among youth (12–17 years) and adults (18–34 and 35–64 years). Differences by sociodemographics and 24-Hour Movement Guideline adherence were assessed with independent t-tests. Associations between school and work ST and health indicators were assessed using adjusted logistic regression.ResultsCanadian youth aged 12–17 years and adults aged 18–34 years reported an average of 4.5 and 5.2 h/day of school ST, respectively. Adults 18–34 years and 35–64 years reported an average of 3.9 and 4.0 h/day of work ST, respectively. School and work ST differed within several subgroups. Among adults 18–34 years, higher school ST was associated with a reduced odds of ‘excellent/very good’ mental health, whereas higher work ST was associated with a greater likelihood of reporting ‘excellent/very good’ general health.ConclusionCanadian youth and working-age adults report an average of 4–5 h/day sedentary at school or work. This is the first study estimating school and work ST in a representative sample of Canadians and will aid in increasing awareness of setting-specific behaviours to better inform targeted interventions including addressing inequalities in ST.

Sex-based differences in the association between loneliness and polypharmacy among older adults in Ontario, Canada.

Emerging evidence shows loneliness is associated with polypharmacy and high-risk medications in older adults. Despite notable sex-based differences in the prevalence in each of loneliness and polypharmacy, the role of sex in the relationship between loneliness and polypharmacy is unclear. We explored the relationship between loneliness and polypharmacy in older female and male respondents and described sex-related variations in prescribed medication subclasses. We performed a cross-sectional analysis of representative data from the Canadian Community Health Survey-Healthy Aging cycle (2008/2009) linked to health administrative databases in Ontario respondents aged 66 years and older. Loneliness was measured using the Three-Item Loneliness Scale, with respondents classified as not lonely, moderately lonely, or severely lonely. Polypharmacy was defined as five or more concurrently-prescribed medications. Sex-stratified multivariable logistic regression models with survey weights were used to assess the relationship between loneliness and polypharmacy. Among those with polypharmacy, we examined the distribution of prescribed medication subclasses and potentially inappropriate medications. Of the 2348 individuals included in this study, 54.6% were female respondents. The prevalence of polypharmacy was highest in those with severe loneliness both in female (no loneliness, 32.4%; moderate loneliness, 36.5%; severe loneliness, 44.1%) and male respondents (32.5%, 32.2%, and 42.5%). Severe loneliness was significantly associated with greater adjusted odds of polypharmacy in female respondents (OR = 1.59; 95% CI: 1.01-2.50) but this association was attenuated after adjustment in male respondents (OR = 1.00; 95% CI: 0.56-1.80). Among those with polypharmacy, antidepressants were more commonly prescribed in female respondents with severe loneliness (38.7% [95% CI: 27.3-50.0]) compared to those who were moderately lonely (17.7% [95% CI: 9.3-26.2]). Severe loneliness was independently associated with polypharmacy in older female but not male respondents. Clinicians should consider loneliness as an important risk factor in medication reviews and deprescribing efforts to minimize medication-related harms, particularly in older women.

Social isolation and mortality among Canadian seniors.

Subjective and objective measures of isolation have been associated with increased risk of mortality in many studies, and some have found differential effects. Canadian Community Health Survey-Healthy Aging data (2008/2009) linked to the Canadian Vital Statistics-Death Database were used to estimate the prevalence of social isolation measured objectively (low social participation) and subjectively (feelings of loneliness and weak sense of community belonging). Associations with death during the 8 to 9 year follow-up period were examined with multivariate Cox proportional hazards models controlling for sociodemographic and health-related characteristics. Structural equation models (SEM) examined direct paths with survival time and indirect effects through health status controlling for covariates that were significant in the Cox models. Analyses were stratified by sex. An estimated 525,000 people (12%) aged 65 or older felt socially isolated and over 1 million (1,018,000) (24%) reported low participation. In multivariate Cox models, low participation was significantly associated with death for men and women even when the potential confounding effects of subjective isolation, socio-demographic characteristics, health status, and health behaviours were considered. Subjective isolation was not associated with death in final multivariate models for men or women. SEM revealed significant associations between low participation and survival time for men and women. In addition to the direct effects, there were significant indirect effects mediated by health status. There were no direct effects of subjective isolation on survival for men or women, only indirect effects mediated through health status. Subjective and objective isolation differed in their association with mortality.

Reduced social participation among seniors with self-reported visual impairment and glaucoma.

ObjectiveSocial participation benefits health. We assessed the relationship between self-reported visual impairment (VI) and glaucoma versus seniors’ social participation.MethodsData from individuals aged ≥65 years responding to the Canadian Community Health Survey Healthy Aging 2008/2009 (n = 16,369) was analyzed. Participation in eight social activities by seniors with and without self-reported VI or glaucoma was compared.ResultsSeniors with VI had significantly reduced participation (p<0.05) in sports/physical activities (18.0% vs. 33.6%), family/friendship activities outside the household (39.7% vs. 53.0%), service club/fraternal organization activities (11.4% vs. 18.4%), volunteer/charity work (13.4% vs. 24.9%), educational/cultural activities (16.2% vs. 24.5%), and other social recreational activities (21.6% vs. 31.0%) compared to those without VI. Differences in participation in church/religious activities (40.6% vs. 44.5%) and community/professional association activities (15.3% vs. 18.0%) were non-significant between seniors with and without VI. Seniors with glaucoma versus those without had significantly reduced participation (p<0.05) in family/friendship activities (46.6% vs. 52.9%), sports/physical activities (26.0% vs. 33.6%) and volunteer/charity work (20.4% vs. 24.9%). No participation in any social activity was significantly higher among seniors with VI versus those without (10.1% vs. 2.9%, p<0.05), but was similar among seniors with and without glaucoma (3.9% vs. 3.1%, p>0.05). After adjusting for the effects of age, sex, education, household income, ethnicity, job status and chronic diseases (adjusted odds ratio, aOR = 3.4 (95% confidence interval (CI) 2.0–5.8), seniors with VI but no glaucoma were more likely not to engage in any social activities compared to seniors without VI and no glaucoma. Seniors with glaucoma but without VI had a similar level of non-participation (aOR = 0.9, 95%% CI 0.5–1.7).ConclusionsSignificantly reduced social participation was found across six community activities among seniors with self-reported VI and in three activities among those with self-reported glaucoma. Policies and programs that help seniors with VI or glaucoma engage in social activities are needed.

Pain and self-rated health among middle-aged and older Canadians: an analysis of the Canadian community health survey\u2015healthy aging

BackgroundPain is an important health problem adversely affecting functionality and quality of life. Though self- rated health (SRH) is a major predictor of mortality, its relationship with pain is not well understood. We explore 1) how pain and age interact to influence SRH, and 2) provincial variations in SRH across Canada.MethodsWe analyzed cross-sectional data from Statistics Canada’s Canadian Community Health Survey-Healthy Aging (n = 30,685), which targeted those 45 years and older and was conducted from 2008 to 12-01 to 2009–11-30. The response rate was 74.4%.The topics covered included socio-demographics, well-being and chronic diseases. We performed both bivariate and multivariate analyses between each predictor and SRH; unadjusted and adjusted odds ratios and 95% confidence intervals are reported. Two-level logistic regression mixed model was used to account for provincial differences. An intraclass correlation coefficient was also computed.ResultsSlightly more than half of respondents (56.40%) were female. In bivariate analyses, those experiencing pain had an odds ratio of 0.20. Which means that the odds of reporting good self-rated health are 4 to 5 times lower for those with pain, compare to the odds of reporting good self-rated health among those without pain (p < 0.001). In multivariate analyses the highly educated, female gender, the never married or single and households with high yearly income were predictors of good health (p < 0.001). Those who reported depressive symptoms, the lonely, the obese, daily smokers and/or the stressed were less likely to rate their health as good (p < 0.001). The influence of pain on SRH was stronger among younger age groups (45–54 years) compared to older age groups (75-84 years, with an odds ratio of 3.53 [p < 0.001] versus 3.14 [p < 0.001]).ConclusionsPain, among other determinants, is associated with SRH. Individuals in rating their health may consider a variety of factors, some of which may not be apparent to health providers. We found that those who reported depressive symptoms, were daily smokers, the obese, the lonely, and/or having a stressful life were less likely to rate their health as good. No significant provincial variations in SRH in Canada was observed in this study.

The influence of walkability on broader mobility for Canadian middle aged and older adults: An examination of Walk Score™ and the Mobility Over Varied Environments Scale (MOVES).

Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008-2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.

Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65years and older.

The prevalence of falls, fall-related injuries, and obesity has increased over the last decade. The objectives of this study were to investigate sex-specific association and dose-response relationship between BMI and falls (and related injuries) among community-dwelling elderly. Our study sample consisted of 15,860 adults aged 65years or older (6399 men and 9461 women) from the 2008-2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA). Falls, fall-related injuries, and BMI measures were self-reported. For both sex, dose-response curves presenting the relationship between BMI, falls, and fall-related injuries were first examined. Thereafter, multivariate logistic regression analyses were also performed to investigate these relationships after adjustment for potentially confounding variables. Of women, 21.7% reported a fall and 16.9% of men. The dose-response relationship between BMI and prevalence of falls showed that underweight and obese individuals reported falling more than normal and overweight individuals; this being more apparent in men than women. Finally, the dose relationship between BMI and prevalence of fall-related injuries showed that only obese men seem more likely to have sustained a fall-related injury. Results from the multivariate analysis showed that obesity in men was significantly associated with higher odds of falling odds ratio (OR) 1.33 (1.04-1.70) and was not significantly associated with higher odds of fall-related injuries OR 1.10 (0.66-1.84) over a 12-month period compared to normal weight men. For women, obesity was not significantly associated with higher fall prevalence OR 0.99 (0.79-1.25) and fall-related injuries OR 0.71 (0.51-1.00). Obesity is associated with self-reported falls, and there appears to be a sex-specific difference in elderly persons.

Age and retirement status differences in associations between the built environment and active travel behaviour

Abstract Background Transport walking and transit use provide opportunities to achieve health-enhancing activity levels within daily routines. Transit access and neighbourhood walkability may influence how readily adults engage in active travel and, ultimately, whether they will. Thus, we aimed to examine associations between Walk Score® and Transit Score® and transit use and transport walking, and to determine whether associations differed across age groups and retirement status. Methods We linked data for Canadian Community Health Survey Healthy Aging Cycle (2008/2009) respondents (aged ≥45 years) from British Columbia ( N =3860) to objectively-measured walkability and transit access. We used logistic regression to examine associations between built environment measures and transport walking and using transit in the past month. We tested whether age group and retirement status were significant moderators of the relation between the built environment and active travel. Results A 10-point higher Walk Score was associated with 34% higher odds of walking for transport (OR=1.34; 95%CI: 1.23,1.47) and 28% higher odds of using transit (OR=1.28; 95%CI: 1.17,1.40). A 10-point higher Transit Score was associated with 37% higher odds of walking for transport (OR=1.37; 95%CI: 1.18,1.60) and 40% higher odds of transit use (OR=1.40; 95%CI: 1.22,1.59). Furthermore, those in neighbourhoods with Excellent Transit / Rider׳s Paradise had over three-and-a-half times higher odds of walking for transport and three times higher odds of using transit than those in neighbourhoods with Minimal Transit/Some Transit ( p Conclusions Transit accessibility and walkability can support active travel behaviour in middle-aged and older adults. Transit access may be especially important in older age groups and walkability may be especially important for middle-aged and older adults who are still working.

Risk factors for falls among seniors: implications of gender.

Despite extensive literature on falls among seniors, little is known about gender-specific risk factors. To determine the prevalence of falls by gender and sociodemographic, lifestyle/behavioral, and medical factors, we conducted a cross-sectional study in a nationally representative sample of Canadian adults who were 65 years of age or older (n = 14,881) from the Canadian Community Health Survey-Healthy Aging (2008-2009). Logistic regression models were applied to investigate gender-specific associations between potential risk factors and falls. In men, stroke (odds ratio (OR) = 1.91), nutritional risk (OR = 1.86), post-secondary school degree (OR = 1.68), eye disorder (OR = 1.35), widowed/separated/divorced marital status (OR = 1.28), and arthritis (OR = 1.27) were independently associated with significantly higher odds of falls. In women, significant independent correlates of falls included stroke (OR = 1.53), age of 85 years or older (OR = 1.51), nutritional risk (OR = 1.39), consumption of at least 1 alcoholic drink per week (OR = 1.39), use of 5 or more medications (OR = 1.36), arthritis (OR = 1.36), diabetes (OR = 1.31), and osteoporosis (OR = 1.22). Higher physical activity levels were protective in both genders, and higher household income was protective in women. Gender should be considered when planning fall prevention strategies.

Spousal caregiving and financial strain among middle-aged and older adults.

We examine whether spousal caregivers face difficulties in meeting their basic household expenses compared to nonspousal caregivers and whether social support mechanisms ameliorate any financial strain from caregiving responsibilities. We use data for caregivers aged 45 and over drawn from a nationally representative, cross-sectional Canadian Community Health Survey--Healthy Aging (N = 5,067). Spousal caregiving is associated with a 35% increase in the likelihood of experiencing difficulties in meeting basic expenses compared to other types of caregiving. Each of social support mechanisms (affectionate, emotional/informational, and positive social interaction), singularly and combined, lessens financial strain from caregiving. Our findings suggest that spousal caregivers are particularly vulnerable because they have fewer resources to draw on for support and perform much more intensive care. Our results highlight the importance of developing appropriate policies and programs to support caregivers.

Correlates of extended sitting time in older adults: an exploratory cross-sectional analysis of the Canadian Community Health Survey Healthy Aging Cycle

Sitting time has been identified as an independent predictor of health; however, little is known of the determinants of extended sitting time among older adults. The purpose of this study was to identify potential sociodemographic, physical environment, health-related and psychosocial correlates of extended sitting time among older adults living independently in the community. Data from adults over the age of 65 from the Canadian Community Health Survey (Healthy Aging Cycle, 2008-2009) were used for analysis (n = 14,560). Self-reported sitting time (<4 or ≥4 h/day) was the main outcome. Age, retirement status, dwelling type, chronic disease, perceived health, body mass index, mood disorder and sense of belonging to community were associated with sitting for 4 or more hours/day. Very low, but not low or moderate, physical activity (OR 1.43; CI 1.19-1.72) was associated with sitting for 4 or more hours/day when compared to those classified as having high physical activity. Several specific correlates of extended sitting time were identified among older males and females; these findings have implications for public health strategies targeting older adults.

Pet Ownership, Other Domestic Relationships, and Satisfaction with Life among Seniors: Results from a Canadian National Survey

ABSTRACTGiven unprecedented aging in the global population along with the physical and psychological challenges associated with aging, it is important to identify ways to protect and promote quality of life for seniors. Previous research has suggested that pet ownership may confer a variety of health and social benefits among seniors. The purpose of this analysis was to determine whether pet ownership was associated with satisfaction with life among Canadian seniors. Quantitative data were obtained from the Canadian Community Health Survey—Healthy Aging, a nationally representative survey of Canadians ≥ 45 years of age conducted between December 2008 and November 2009. Analyses were restricted to a subsample of 11,973 individuals ≥ 65 years of age, and multiple logistic regression was used to model the relationship between pet ownership and satisfaction with life while controlling for sociodemographic factors. The final model was stratified to detect interaction. Pet ownership was negatively correlated with satisfaction with life in the sample as a whole (AOR = 0.79, 95% CI = 0.72–0.87) and among those who were married, in common-law relationships, and/or lived with others, while no association was found among those who were widowed, single, or living alone. Among those who were both divorced and living alone, pet ownership demonstrated the potential for being associated with greater satisfaction with life (AOR = 1.24, 95% CI = 0.89–1.73). Overall, this analysis showed that the relationship between seniors and their pets is complex. Whether pet ownership correlates with satisfaction with life appears to depend on the presence and nature of other domestic relationships.